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PubMed1997

Anal ultra slow waves: a smooth muscle phenomenon associated with dyschezia.

Anal ultra slow waves (USWs) have been described in a variety of anorectal disorders, all of which may be associated with constipation. We investigated whether they represent a marker for dyschezia and whether their occurrence can be modified. Manometric and endosonographic studies were performed in 25 patients with dyschezia, in 25 age- and sex-matched controls, and in an equal number of patients with hemorrhoids. Patients exhibiting ultra slow waves were repeatedly studied with and without local administration of isosorbide dinitrate. In addition, we determined whether stimulatory maneuvers modify the occurrence of USWs. Anal USWs were persistently found in 56% of patients with dyschezia, in 8% of patients with hemorrhoids, and in none of the healthy controls. They were stimulated by anal squeeze and completely abolished by local administration of isosorbide dinitrate. Ultra slow waves always occurred in conjunction with an increase in anal resting pressure and were tightly associated with a fluctuation in slow wave amplitude. Anal sphincter morphology was similar in patients with dyschezia and in controls. We conclude that anal USWs occur most frequently in patients with dyschezia and indicate smooth muscle dysfunction. Treatment directed at abolishing this motor phenomenon may represent a novel approach to the management of patients with dyschezia.

Adult↗
PubMed2007

Common anorectal problems.

Children, just as adults, have a variety of common anorectal problems that can be quite bothersome. The presentation of these problems may be age-specific. Abscesses, fistulas, and fissures appear more commonly in infants and young children, whereas hemorrhoids and pilonidal disease are more common in teens and young adults. Fissures often can be treated medically but may require surgical treatment with lateral internal sphincterotomy. Abscesses and fistulas are common in infant males, especially robust infants who are breastfed. They may resolve with medical therapy but anal fistulotomy is not infrequently required. Hemorrhoids are rare in young children but may be an issue for teenagers. Acute symptomatic lesions may require excision if local measures cannot control the symptoms. Finally, pilonidal disease is a difficult problem for the patient and the surgeon. Persistently symptomatic lesions demand some type of surgical treatment but wound healing is poor in the intergluteal cleft region. More extensive procedures requiring the transfer of fasciocutaneous flaps may be necessary to provide definitive relief. Anorectal problems in infants and children are frequent and bothersome. Although most are not associated with tremendous morbidity, they can lead to much patient and parent anxiety as well as frequent medical consultation until the problem is successfully treated or resolves.

Abscess↗
PubMed1992

Office management of common anorectal problems.

Common anorectal problems can often be treated in the office setting. Hemorrhoids are usually relieved with use of bulk laxatives or stool softeners; if this fails, coagulation or rubber band ligation may be effective. Surgical therapy is still preferred for third- and fourth-degree hemorrhoids. Perirectal and perianal abscesses are treated by drainage, but in up to 30% of cases a fistula occurs following treatment. Surgical evaluation is appropriate when a fistula is suspected. Acute anal fissures often heal with conservative management; sphincterotomy may be needed for chronic fissures. Anal warts tend to recur and require several treatment sessions with use of ablative techniques.

Aged↗
PubMed1998

Effects of various laser wavelengths and energy levels on pig rectal submucosal tissue.

This phase I animal study attempts to develop a nonexcisional method of treating hemorrhoidal varicosities submucosally using interstitial laser beam. Three laser wavelengths at four energy levels were applied interstitially to pig rectal submucosa to evaluate the effects on the vasculature, mucosa, and the muscle. As expected YAG laser caused a "cooking" of the tissue with necrosis and abscess formation. KTP laser was intermediate in its effect, causing less mucosal injury and muscle necrosis. Pulse dye laser had more specific effects on the vessels with little damage to the mucosa or muscle layers. Further studies using pulse laser are warranted as a possible nonexcisional interstitial treatment for hemorrhoids.

Animals↗
PubMed1998

Colonic disease in cirrhotic patients with portal hypertension: an endoscopic and clinical evaluation.

Fifty cirrhotic patients with portal hypertension but without colonic or systemic disease underwent lower gastrointestinal endoscopy in order to investigate the effects, if any, of portal hypertension on the colon. Fifty patients without liver or systemic disease, examined by colonoscopy because of irritable bowel syndrome in the same period served as controls. Rectosigmoid varices were observed in 34% of the cirrhotic patients and 2% of the controls. Hemorrhoids were observed in 70% of the cirrhotic patients and 48% of the controls. Multiple vascular-appearing lesions were found in 16% of the cirrhotic patients and 6% of the controls. Nonspecific inflammatory changes were noted in 10% of the cirrhotic patients and 4% of the controls. Simultaneous presence, in the same patient, of rectosigmoid varices, hemorrhoids, multiple vascular-appearing lesions, and nonspecific inflammatory changes, was observed in only five (10%) of the cirrhotic patients. We found polyps in 12% of the cirrhotic patients and 14% of the controls, and a malignant tumor in 4% of the cirrhotic patients. The patients with normal colonoscopic findings were 8% of the cirrhotic patients and 36% of the controls. All patients and controls were followed up for 1 year; there was no gastrointestinal hemorrhage among controls, whereas 34% of the cirrhotic patients had an upper gastrointestinal hemorrhage (88% from esophageal varices, 12% from the stomach) and 4% had a lower gastrointestinal hemorrhage (one from rectosigmoid varices and one from nonspecific inflammatory lesions). Colonic lesions were significantly more frequent in the cirrhotic patients (92%) than in the control group (64%); however, such lesions did not seem specific to the disease and were not statistically correlated with the degree of esophageal varices by Child's grading, the etiology of cirrhosis, or the bleeding risk from the lower gastrointestinal tract.

Adult↗
PubMed1998

Etiology and outcome of lower gastrointestinal bleeding in patients with AIDS.

OBJECTIVE: The objective of the study was to investigate bleeding (LGIB) in patients with acquired immunodeficiency syndrome (AIDS). METHODS: All hospitalized AIDS patients with LGIB evaluated by the gastroenterology service at a large city-county hospital during a 6 yr period were identified by database review and by endoscopy and consultation records. RESULTS: Of the 691 AIDS patients seen during the study period, 18 (2.6%) (median age 41+/-7 years) were evaluated for LGIB. In these patients, LGIB was caused by human immunodeficiency virus type 1 (HIV)-associated disorders in 72% including cytomegalovirus colitis in seven patients, idiopathic colonic ulcers in five patients, and intestinal Kaposi's sarcoma in one patient. HIV-associated thrombocytopenia contributed to substantial bleeding from hemorrhoidal disease in two patients. Rebleeding occurred in four patients (22%), including hemorrhoids in three and idiopathic colonic ulcers in one. Surgery was not performed in any patient. Following the institution of ganciclovir therapy, no patient with CMV colitis had recurrent bleeding. The in-hospital mortality was high (28%), although bleeding was the direct cause of death in only one patient. CONCLUSIONS: LGIB is infrequent in patients with AIDS and is usually caused by opportunistic diseases specifically related to immunodeficiency. Although some of these conditions are potentially treatable medically, in-hospital mortality is high and long-term prognosis is poor because of AIDS-related comorbidity.

AIDS-Related Opportunistic Infections↗
PubMed2000

Correlation between chronic prostatitis syndrome and pelvic venous disease: a survey of 2,554 urologic outpatients.

OBJECTIVES: In this study we evaluated the association between chronic prostatitis syndrome (CPS), varicocele and hemorrhoids as manifestations of a pelvic venous disease. METHODS: Our retrospective study was based upon 2,554 patients treated in two general urology clinics over the past 10 years. We have assessed the incidence of CPS among urological patients. RESULTS: We found 483 patients with CPS, representing 18.9% of the total number of visits at the outpatient clinic. In this group the percentage of varicocele and hemorrhoids was 14.69 and 8.48%, whereas in a control group these figures were 5.02 and 5.84%, respectively (p<0.001 and 0.1054). Such a difference is statistically significant and suggests a higher prevalence of varicocele in the CPS group, but this may be due to a methodological error of the retrospective study. CONCLUSION: Only a prospective study, which is of importance due to the frequency of the disease, can give a precise answer to this question.

Case-Control Studies↗
PubMed1999

Identification of anti-endothelial cell antibodies in patients with chronic anal fissure.

BACKGROUND: Recent studies demonstrate that chronic anal fissure can be the consequence of a local ischemic process. Thus hypothesizing that at the perianal level the interaction of immune component with endothelium could constitute a mechanism determining ischemia and hypertonia, the presence or absence of circulating anti-endothelial cell antibodies (AECAs) was determined in the serum of patients with anal fissure. METHODS: The study was carried out on 30 patients: 10 with posterior chronic anal fissure (group 1), 10 with grades III and IV hemorrhoids (group 2), and 10 without previous or active anorectal disease, or both (group 3). An indirect immunofluorescence assay on sections of rat kidney tissue was used to identify AECA in the peripheral blood. RESULTS: The assay result was positive for AECAs in 12 patients, all with anorectal disease when compared to the control group (P = .001). The basal anal tone was higher in the AECA-positive patients than in the AECA-negative patients (P = .001). CONCLUSIONS: Only the patients with anal fissure or hemorrhoids were AECA positive. All healthy controls tested negative for AECA. Although the number of subjects studied is small, the presence of auto-antibodies directed against the endothelial cells in the serum of these patients supports the hypothesis that the endothelium is involved in the anal disease.

Adult↗
PubMed2001

[Improvements of Milligan-Morgan hemorrhoidectomy].

During the period from 1994 to 2000 there were investigated and treated 240 patients with hemorrhoids which required the surgical intervention. Depending on the hemorrhoidectomy method all the patients were divided into two groups--the main and the control. The main group was consisted of 128 persons. In this group the hemorrhoidectomy was performed according to the method developed by us with the use of ligation device during removal of internal hemorrhoids. The control group was consisted of 112 persons in whom the hemorrhoidectomy was performed according to conventional methods.

Digestive System Surgical Procedures↗
PubMed2001

Preservation of anal sphincter function after hemorrhoidectomy under local anesthesia.

BACKGROUND: This is a prospective study designed to confirm a simple, effective method of hemorrhoidectomy that can be accomplished by simple local anesthesia with good preservation of anal sphincter function both clinically and manometrically. METHODS: Eighty consecutive patients with prolapsed mixed hemorrhoids were operated with standard closed hemorrhoidectomy under local anesthesia. Pre- and post-operative assessments of anal continent function and anorectal manometry were performed. Maximal basal pressure (MBP), maximal contraction pressure (MCP), squeeze pressure (SP), rectoanal inhibitory reflex (RAIR), functional length (FL), volumes at the first sensation of rectal fullness (V sense), urge of defecation (V urge), and intolerance (V max.) were measured. The pre-and post-operative data were compared with two tailed paired Student t test. Statistical significance was considered asp-value less than 0.05. RESULTS: All 80 patients were completely followed up and studied. No patient had any degree of anal incontinence before and 6 months after hemorrhoidectomy. There was significant change in V sense and V urge after operation. However, MBP, MCP, SP, FL, RAIR, and V max. remained unchanged. CONCLUSIONS: Standard closed hemorrhoidectomy supplemented with appropriate submucosal dissection under adequate local anesthesia is simple and effective for the treatment of prolapsed hemorrhoids. The function of anal sphincter, both clinically and manometrically, can be well preserved.

Adult↗
PubMed2003

[Milligan-Morgan hemorrhoidectomy with a radiofrequency scalpel].

BACKGROUND: Postoperative pain has always been the main adverse effect of surgical treatment for hemorrhoids. Therefore, surgical techniques evolved mainly to solve this problem and, secondly, postoperative bleeding, recurrences and stenosis. METHODS: Two homogeneous groups of 20 patients each were investigated. Both of them were affected by fourth grade hemorrhoidal prolapse and were homogeneous for age, sex and presentation symptoms. Patients previously treated for other proctologic diseases were excluded. A group was treated with standard Milligan-Morgan hemorrhoidectomy and the other with radiofrequency scissors. Every patient underwent a follow-up protocol based on outpatient visits at 15, 30, 45 postoperative days and 3, 6 and 12 months. RESULTS: The results show a substantial similarity between these techniques. However, radiofrequency scissors further improved the simplicity of the technique and the postoperative adverse effects. In particular, the procedure lasted 7 minutes less with radiofrequency scissors. Patients treated with the radiofrequency technique had their first postoperative evacuation 24 hours before the standard technique and reduced the mean postoperative hospital stay at 2.5 days (4.5 days in the standard group). The incidence of postoperative pain was reduced in patients treated with radiofrequency scalpel and the follow-up controls in both groups didn't show any complication as stenosis or incontinence. CONCLUSIONS: The radiofrequency-performed Milligan-Morgan hemorrhoidectomy is a valuable technique that improves the classical difficulties in execution, reducing the length of hospital stay and the incidence of postoperative pain or other complications.

Adult↗
PubMed2003

[Stapled hemorrhoidectomy--early experience in 30 patients].

INTRODUCTION: We report the early results of 30 patients treated by stapled hemorrhoidectomy. PATIENTS AND METHODS: Thirty patients with symptomatic grade 2-4 hemorrhoids were treated by stapled hemorrhoidectomy. The procedure was performed with a 33 mm diameter automatic hemorrhoidal circular stapler. The patients were prospectively evaluated for immediate and functional recovery, postoperative pain and subjective success of the treatment. RESULTS: The median age of the patients was 46.2 years, and the median duration of the symptoms was 27 months. The main symptom was bleeding (in 96% of the patients). The average operative time was 22 minutes. The operation was performed with spinal (63.3%) or general (36.7%) anesthesia. There was no mortality, urinary retention, incontinence, fecal urgency or persistent pain. One patient, who was under anticoagulant treatment, had postoperative bleeding, which required transfusion of 3 units of blood, and another patient was operated on because of perforation of the sigmoid colon. Most patients (twenty eight) had complete functional recovery and returned to their usual daily activities within 10.4 days. Postoperative pain and subjective success were evaluated by a 1 to 10 scale. The average pain score decreased from 5.8 on the first postoperative day to 2.4 on the 7th postoperative day. The average satisfactory score was 9.2. CONCLUSION: Stapled hemorrhoidectomy is an alternative to conventional surgical hemorrhoidectomy. The procedure seems to be associated with less postoperative pain and early recovery with a high satisfaction rate among patients.

Hemorrhoids↗
PubMed1992

Treatment of common anorectal disorders.

Family physicians can manage most common anorectal disorders seen in office practice. Proctitis is usually caused by sexually transmitted infections that can be treated with antibiotics. Pruritus ani, anal fissures, fungal infections and hygiene problems are all amenable to simple treatments. Thrombosed external hemorrhoids can be opened and drained. Bleeding or symptomatic internal hemorrhoids can be treated with rubber-band ligation. Perirectal or ischiorectal abscesses require incision and drainage, sometimes under general anesthesia. Serious disorders such as inflammatory bowel disease and cutaneous malignancies should always be considered in the differential diagnosis of common anorectal disorders.

Abscess↗
PubMed2004

[Open hemorrhoidectomy with using the apparatus controlled bipolar electrocoagulation].

Hemorrhoids are known to be a widely spread disease. The aim of this study was to compare two methods of hemorrhoidectomy. The hemorrhoidectomy was performed on 262 patients with combined III-IV degree hemorrhoids, 130 patients being operated by the conventional method--Milligan-Morgan hemorrhoidectomy, 132 patients undergoing hemorrhoidectomy using a bipolar vessel sealing system. It was noted that the operation time was significantly shorter, postoperative pain and postoperative complications less frequent due to the bipolar device-controlled electrocoagulation.

Adult↗
PubMedDate not supplied

[Stapled hemorrhoidopexy in the treatment of hemorroidal prolapse].

In the treatment of hemorroidal prolapse, stapled hemorrhoidopexy, according to the Longo's technique, represents an innovative and interesting procedure. The Authors consider own experience in the years 2001-2002, estimating preliminary results in the treatment of 50 patients affected by hemorrhoidal disease classified as III-IV grade, associated with mucosal prolapse, rectocystocele in 5 cases, anal fissures in 6 and hyperplastic polyp in 1. The patients were submitted to mucosal prolapsectomy with mechanical stapler (PPH 01-33 Ethicon), applying haemostatic stitch on suture line, apart from intraoperative bleeding, associated to closed anal sphincterotomy in 6 cases, and resection of anal hyperplasic polyp in 1. In 5 cases of rectocystocele a Burch's culposuspension was associated to a stapled transanal rectal resection (STARR). After 3 and 12 months the Authors performed ano-rectoscopy, anal manometry and defecography. Mean operative time was 45 minutes (range 20'-130') and mean hospital stay was 3 days (range 2-6 days). In the early postoperative course urinary ritention in 4 cases, treated with temporary catheterization in 3 and permanent for 72 hours in 1, was observed. Only 1 patient, was reoperated in day-surgery and with loco-regional anesthesia for residual fibrous hemorroid. Bleeding, severe pain, anal stenosis, impairment of continence were not observed. According to the Literature data, our experience confirm that mucoprolapsectomy represents an innovative, safe, simple and definitive operation in the treatment of hemorrhoids disease. In case of rectal prolapse associated to external fibrous hemorroids, a combined surgical treatment is requested in order to achieve better results.

Adult↗
PubMedDate not supplied

[Milligam-Morgan hemorrhoidectomy and stapled mucoprolapsectomy. Clinical comparison of the results].

The aim of this retrospective study was to assess the results of treatment for hemorrhoids by Milligan-Morgan hemorrhoidectomy and by stapled mucoprolapsectomy in terms of operative time, postoperative pain, lenght of hospital stay, incidence of early and late complications, time to return to work and to normal social activities and patient satisfaction. Between January 2002 and December 2003, a total of 65 patients with hemorrhoids (35 men and 30 women with a mean age of 46.9 years) underwent surgical treatment: 41 patients underwent conventional hemorrhoidectomy and 24 patients stapled mucoprolapsectomy. All patients were contacted by phone or were reviewed in the outpatient clinic with a mean follow-up of 2 months (range 8-31). The Authors emphasize that it is difficult to make an objective comparison between hemorrhoidectomy and stapled mucoprolapsectomy because the two procedures are completely different in terms of rationale and technique; however, stapled circumferential mucosectomy in their experience causes less postoperative pain and bleeding and can be considered a valid therapeutic option for third- and fourth-degree disease.

Adolescent↗
PubMedDate not supplied

[Rectal stenosis after stapler hemorrhoidopexy].

We report a case of a 52-year-old woman with hemorrhoids submitted to Procedure for Prolapse and Hemorrhoids (PPH), i.e. stapled hemorrhoidopexy, using a modified Longo's technique (double purse string) to treat an associated rectocele and rectal prolapse; the STARR technique (Stapled Trans Anal Rectal Resection) was not yet codified. The post-operative course was uneventful and the patient is discharged in II p.o. day. In fifth post-operative day the patient came back with an unusual rectal stenosis due to the superior purse string. The stricture was easily resolved by 'opening' the purse string with a transanal approach in outpatient setting.

Constriction, Pathologic↗
PubMed2006

Closed vs ligasure hemorrhoidectomy: a prospective, randomized clinical trial.

OBJECTIVE: To compare the operative time, postoperative complications, and analgesic requirement between closed hemorrhoidectomy and Ligasure hemorrhoidectomy. MATERIAL AND METHOD: The study was conducted in a prospectively randomized controlled fashion. Forty-seven patients with grade 3 or 4 hemorrhoids plus external component or skin tag were operated on by either hemorrhoidectomy with Ligasure (24 patients) or closed hemorrhoidectomy (23 patients). One patient in each group was lost to follow up. The operative time, postoperative verbal numeric pain score, analgesic requirement, bleeding, and wound dehiscence between the two groups were compared Unpaired t-tests, Mann-Whitney U tests, or Fisher's Exact tests were used where appropriate. RESULTS: Demographic and clinical data between two groups were comparable. Operative time for the Ligasure hemorrhoidectomy was significantly shorter than the closed hemorrhoidectomy group (21.70 +/- 11.76 vs 35.68 +/- 14.25 min, p < 0. 001), while the number of resected hemorrhoids in the study group were 2.91 versus 2.18 in the control group. However, there were no differences in post-operative pain score, analgesic requirement, bleeding, or wound dehiscence between the two groups. CONCLUSION: Ligasure hemorrhoidectomy is superior to closed hemorrhoidectomy in terms of reducing the operative time without affecting postoperative complications.

Adult↗